Pursuing an Asian Health Network

Malvinder Singh, one of the richest Indians, aims to improve care in one of the fastest-growing health markets, which also has few formal services.

WAYNE ARNOLD

SINGAPORE — No matter how healthy or rich Asian economies are, one thing is certain: Asians will never stop getting sick.

That helps explain why Malvinder Singh left his home in New Delhi this year to move to Singapore. He first made a fortune in 2008 selling the generic-drug giant that his family built, Ranbaxy Laboratories. Now, Mr. Singh, 37, is trying to expand Fortis Healthcare, another of the family companies, from a string of hospitals around the Indian subcontinent into a pan-Asian health care network.

“There is a huge opportunity for growth in Asia for health care,” Mr. Singh said in a recent interview. “There are multiple markets which need investment that we would want to be a part of.”

Fortis suffered a major setback in July when its bid to acquire Parkway Holdings, a regional hospital operator based in Singapore, lost out to a higher bid from Malaysia’s sovereign wealth fund. But Mr. Singh, who has a master’s degree in business administration from Duke in North Carolina, said he was undeterred.

Having spent almost $1 billion in the last two years buying up assets in health care and other sectors around the world, he said he was already scouting for new targets.

The attraction is clear: with a population of more than 1.1 billion, most with no access to formal health care, India represents one of the fastest-growing health care markets. And the country’s relatively low costs are increasingly attracting medical tourism patients from abroad.

“There’s a good amount of opportunity for the business to be transferred from patients migrating from other countries to India for treatment,” said Ranjit Kapadia, an analyst at HDFC Securities in Mumbai.

But Mr. Singh is after much more: not only a slice of China’s 1.3 billion people and Indonesia’s 227 million, but also the emerging class of affluent Asian medical tourists, many of whom flock to Singapore for quality private care. By building a regional network of hospitals, moreover, he hopes to bring better care to the poorest parts of India.

“The challenge for the country and for us as health care providers is to see how to create a model where you’re able to create infrastructure and investment in health care and bring it closer to the people, so it’s more accessible,” said Mr. Singh, the Fortis chairman.

Many in India still wonder why Mr. Singh and his younger brother, Shivinder, decided to walk away from their pharmaceutical company, which has deep ties in their family.

Two of Mr. Singh’s great-uncles, Ranbir and Gurbax Singh, started Ranbaxy in 1937 as a distributor for the Japanese drug maker Shionogi. When the brothers ran into financial trouble, they turned to Mr. Singh’s grandfather for a loan. In 1952, when they could not repay him, they made him a partner.

Malvinder’s father, Parvinder, returned to India from the United States in 1967 with a master’s degree in pharmacy from Washington State University and a doctorate from the University of Michigan, and went to work at Ranbaxy, eventually taking it over and changing it into a generic-drug maker from a drug distributor.

When Parvinder Singh died in 1999, his two sons inherited his 33.5 percent stake in Ranbaxy. Malvinder Singh climbed the ladder onto the company’s board in 2003, and in 2006 he became managing director and chief executive.

Along with another Indian drug company, Dr. Reddy’s Laboratories, Ranbaxy became known globally for overturning big drug companies’ patents in court fights and then churning out lower-cost versions of their best-selling products.

By the middle of the decade, though, competition from cheap generics was proving as tough on generic-drug makers as it was on big pharmaceutical companies. In 2005, Ranbaxy’s profit fell by two-thirds and its share price by nearly a half.

So in 2008, the Singhs sought a solution by marrying Ranbaxy to the Japanese drug maker Daiichi Sankyo. For Daiichi Sankyo, Ranbaxy offered low-cost manufacturing and access to 60 new markets, including crucial emerging markets like India, to offset falling sales at home.

“We had what they wanted,” Mr. Singh said.

Selling their stake in the company to the Japanese earned the Singhs $2.3 billion, vaulting them to No. 13 on Forbes magazine’s ranking of the richest Indians. Mr. Singh retained his position as head of the company.

In September 2008, however, the Food and Drug Administration in the United States banned 30 Ranbaxy drugs made at two of the company’s Indian plants, citing manufacturing problems uncovered that year. Ranbaxy’s stock dropped by two-thirds, and in May 2009, the company replaced Mr. Singh as chief executive and paid him a severance of 480 million rupees, or $9.6 million.

Mr. Singh declined to discuss the F.D.A. case or his departure from Ranbaxy. “Once I left Ranbaxy, I’ve not spoken on what they’re doing or what we’ve done,” he said. He added, however, that the company’s fortunes and its shares, had largely recovered.

Mr. Singh turned to another family company, Fortis Healthcare. Founded in 1996 and named after the Greek word for strength, Fortis has grown from a single hospital in northwest India into a network of 48 hospitals and clinics.

Last year, the Indian health care market was estimated at $38 billion, and given the country’s fast-growing, increasingly affluent population, more and more Indians are suffering from lifestyle diseases common to developed countries. India already has the largest number of diabetics in the world after China, for example, yet Indians, on average, spend only $55 a year on health care.

“There’s a huge gap in India,” Mr. Singh said. “The health care market in India is very fragmented. The corporatization of health care is still emerging.”

While 70 percent of the country’s hospitals are government-run, private hospitals treat 70 percent of all patients, he said. And most private hospitals are small, with fewer than 30 beds, providing a big opportunity for larger operators like Fortis to use economies of scale to lower prices and increase profits. By introducing more advanced treatment methods, Fortis also aims to lower the average patient stay, allowing it to increase volume.

To achieve the advantages of size, Fortis embarked on an acquisition spree, acquiring three hospital chains in India from 2005 to 2009. The company now has 10 more hospitals under construction.

In March, Fortis leaped overseas, buying 24 percent of Parkway from the private equity firm TPG for $685.3 million. With hospitals in Malaysia, China and India, Parkway gave Fortis a foothold across Asia. The chain is also popular with medical tourists; a third of its patients in Singapore come from abroad, mainly from Indonesia.

Some analysts expressed doubt about whether Fortis could benefit from an international network. Unlike the managers and engineers who follow manufacturing investments overseas, doctors and nurses often cannot work in countries where they are not licensed. “I don’t know who can add more value to whom,” Lynette Tan, an analyst at the Singapore brokerage DMG & Partners, said of the Fortis-Parkway link.

But Mr. Kapadia at HDFC said the economies of scale came not from personnel but from purchasing. With more hospitals, Fortis stands to get lower prices for drugs, supplies and equipment, he said, adding: “A hospital is not only its doctors.”

Losing out on its bid to take over the rest of Parkway, therefore, was a blow to Fortis’s strategy. The Malaysian investment fund Khazanah Nasional Berhad won Parkway with a higher bid than Fortis’s. “We were not keen to get into a bidding war,” Mr. Singh said.

Fortis instead reaped a profit of 116.7 million Singapore dollars, or about $86 million, by selling its share of Parkway to Khazanah. The problem for Fortis now is that there are few pan-Asian players as big as Parkway for it to buy. “There isn’t any other very obvious candidate,” said Anni Kum, an analyst at Kim Eng Securities in Singapore.

As a result, Mr. Singh said, Fortis is now considering moving into hospital management as an alternative.

“An acquisition to get kick-started might be the way to start,” he said. “But that doesn’t mean it’s the only way.”

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